Peeking into Peds 

This has been a banner year for babies amongst my daughter’s friends circle. It’s too bad they’re spread all over the country, but that’s the way it is these days, isn’t it? Anyway, one of these babies has been having a difficult time lately.  

If you remember, I created SlowItDownCKD way back in 2011. I have never written about pediatric kidneys. But I was more than curious about how I might be able to help this young woman and her husband understand what her baby was going through. Therefore, welcome to my first blog concerning pediatric kidneys. 

This baby boy’s problems started with RSV. What’s RSV? Let’s allow the Centers for Disease Control and Prevention answer that question: 

“Respiratory syncytial (sin-SISH-uhl) virus, or RSV, is a common respiratory virus that usually causes mild, cold-like symptoms. Most people recover in a week or two, but RSV can be serious, especially for infants and older adults. RSV is the most common cause of bronchiolitis (inflammation of the small airways in the lung) and pneumonia (infection of the lungs) in children younger than 1 year of age in the United States.” 

You’re probably asking yourself what the lungs have to do with the kidneys at this point. An article in the Journal of Nephrology explains: 

“A significant interaction between kidneys and lungs has been shown in physiological and pathological conditions. The two organs can both be targets of the same systemic disease (eg., some vasculitides [Gail here: That means one of the disorders that inflame blood vessels to the point of destroying them.]). Moreover, loss of normal function of either of them can induce direct and indirect dysregulation of the other one.” 

The little tyke in question tested positive for a UTI. Take a look at what Johns Hopkins Medicine has to say about UTIs: 

“A urinary tract infection is inflammation of part of the system that takes urine out of the body. It’s caused by bacteria. The urinary tract includes the two kidneys. They remove liquid waste from the blood in the form of urine. Narrow tubes (ureters) carry urine from the kidneys to the bladder. Urine is stored in the bladder. When the bladder is emptied, the urine travels through a tube called the urethra and passes out of the body. Bacteria can infect any part of this system.” 

The baby’s UTI was determined to be caused by E. coli. I have to admit I didn’t know much about E. coli, so I turned to UpToDate, an easily understood medical site for professionals [and seemingly lay people], and not only found information about E. coli, but more about UTIs: 

“In healthy children, most urinary tract infections (UTIs) are caused by Escherichia coli (E. coli) bacteria, which are normally found in stool. These bacteria can move from the anus to the urethra and into the bladder (and sometimes up into the kidney), causing infection. 

Risk factors — Some children have a higher chance of developing a UTI. The following are some risk factors for UTI: 

● Young age – Males younger than one year old and females younger than four years of age are at highest risk.   

●Being uncircumcised – There is a four to 10 times higher risk of UTIs in uncircumcised males. Still, most uncircumcised males do not develop UTIs. …   

●Having a bladder catheter for a prolonged period of time.   

●Having parts of the urinary tract that did not form correctly before birth.   

●Having a bladder that does not work properly or constipation (bladder and bowel dysfunction [BBD]).   

●Having one UTI slightly increases the chance of getting another UTI.”  

My daughter explained that her friend’s little boy was uncircumcised and had both catheters [although not for extended periods] and UTIs before. Then she asked why the baby needed an ultrasound. As always, I told her I’d try to find out.  

I not only found out, but discovered information about the other test this baby is taking: 

“For a renal ultrasound, warm jelly is placed on the abdomen and back and a probe is moved over the surface of the skin. This produces a special kind of picture of the kidney and bladder. This picture shows the size of the kidneys and the bladder, and if there are any other problems such as previous scarring or swelling of the kidneys (hydronephrosis) or thickening of the bladder wall. 

A voiding cystourethrogram is a test where a small tube called a catheter is inserted in the bladder. The bladder is filled with a dye and x-rays are taken. Once the bladder is full, the child is asked to urinate and x-rays are taken again. If the fluid with the dye is seen backing up the ureters to the kidneys, reflux is present.” 

Thank you to Dartmouth Health Children’s for educating us about the renal ultrasound and the voiding cystourethrogram. Even though a three month old baby cannot urinate on demand [At least, I don’t think he can.], the catheter will help obtain the urine.  

Maybe a reminder of how urine works would be helpful here. This is from Cincinnati Children’s Health Library: 

“The kidneys filter the blood and make urine. Urine goes from the kidneys to the bladder through tubes called ureters. Where the ureters and the bladder join, there is a valve-like mechanism. This mechanism prevents the urine from backing up to the kidneys. As the bladder fills with urine, it sends a message to the brain. The brain then sends a message to the sphincter muscle to relax, while the bladder muscle squeezes, allowing the bladder to empty. This is called voiding or urination.”   

I think I skipped over ‘reflux.’ Let me check. Hmmm, I did. Okay, in this case reflux refers to the backing up of the urine. Well, it is a little more complex than that. Back to Cincinnati Children’s Health Library for us: 

“Vesicoureteral reflux (VUR) is a condition in which urine from the bladder is able to flow back up into the ureter and kidney. It is caused by a problem with the valve mechanism. Pressure from the urine filling the bladder should close the tunnel of the ureter. It should not allow urine to flow back up into the ureter. When the ureter enters the bladder at an unusual angle reflux can can [sic] occur. This can also happen when the length of the ureter that tunnels through the bladder wall is too short. 

VUR becomes a problem when the urine in the bladder gets infected. The infected urine travels backward to the kidney. This can cause a kidney infection. Kidney infections lead to kidney damage.” 

Don’t panic, mother of this babe. The reflux is graded from 1-5. In most cases of grades 1-3, the condition will correct itself as your baby matures. The baby will need to take antibiotics on a daily basis, however. 

There’s even more information available about urine reflex and how to treat it in babies, but this is a blog – not a book – so I’ll have to stop now. To the mother of this little boy, I hope I’ve helped you understand a bit better. 

Until next week, 

Keep living your life!